Columbus State Community College Student Leadership Conference Nov 8-9, 2013

1. CLCO 2013 Workshop and presentation application form
1
A
Leader’s
Legacy:
Making
history
every
day
2013
Collegiate
Leadership
Conference
of
Ohio
Workshops
and
Presentation
Application
This
year,
Student
Engagement
and
Leadership
(SEaL)
will
commemorate
Columbus
State’s
50th
Anniversary
by
empowering
the
next
generation
of
college
students
to
develop
their
leadership
skills,
construct
a
professional
network,
and
make
a
difference
through
civic
and
community
engagement.
This
year’s
conference,
“A
Leader’s
Legacy:
Making
History
Every
Day”
will
engage
students
through
workshops
(including
a
special
track
for
“First
Generation”
college
students),
keynote
speakers
and
community
service
projects.
The
conference
will
encourage
college
students
to
make
history
every
day
by
investing
themselves
in
the
world
around
them
and
by
actively
participating
in
their
own
leadership
evolution.
Application
Deadline:
September
27,
2013
Presenter
Information
Workshop
Title:
Co-­‐presenter(s)
if
Applicable
Co-­‐presenter
1
–
Name:
Title:
Institution/Organization
Name:
Email:
(All
communication
from
the
Planning
Committee
will
go
to
this
address.)
Address:
State:
Phone:
City:
Zip:
Fax:
City:
Co-­‐Presenter
1
Bio
Please
provide
us
with
a
short
bio
with
which
this
presenter
would
like
workshop
hosts
to
introduce
her
or
him:

2. CLCO 2013 Workshop and presentation application form
2
Co-­‐presenter
2
–
Name:
Title:
Institution/Organization
Name:
Email:
(All
communication
from
the
Planning
Committee
will
go
to
this
address.)
Address:
State:
Phone:
City:
Zip:
Fax:
Co-­‐Presenter
2
Bio
Please
provide
us
with
a
short
bio
with
which
this
presenter
would
like
workshop
hosts
to
introduce
her
or
him:
Co-­‐presenter
3
–
Name:
Title:
Institution/Organization
Name:
Email:
(All
communication
from
the
Planning
Committee
will
go
to
this
address.)
Address:
State:
Phone:
City:
Zip:
Fax:
Co-­‐Presenter
3
Bio
Please
provide
us
with
a
short
bio
with
which
this
presenter
would
like
workshop
hosts
to
introduce
her
or
him:

3. CLCO 2013 Workshop and presentation application form
3
A
Leader’s
Legacy:
Making
history
every
day
Workshop
Information
Workshop
Title:
Presenters:
Abstract
-­‐-­‐
REQUIRED
Please
provide
a
50-­‐word
abstract
of
your
workshop
to
be
used
in
conference
materials
(CLCO
reserves
the
right
to
edit
as
needed):
Workshop
Goals
and
Learning
Outcomes
Please
provide
an
outline
of
your
workshop's
goals
and
learning
objectives.
Workshop
Outline
Please
describe
how
your
workshop
will
achieve
the
above
stated
goals
and
how
participants
will
be
actively
engaged.
Workshop
Focus
Please
indicate
which
focus
best
describes
your
workshop.
 Leadership
Skills
 Constructing
a
Professional
Network
 Making
a
Difference
through
Civic
and
Community
Engagement
 The
Evolution
of
a
Leader
 First
Generation
College
Students:
Blazing
a
New
Trail

4. CLCO 2013 Workshop and presentation application form
4
Conference
Theme
Please
describe
how
your
workshop
relates
to
the
CLCO
2013
theme
–A
Leader’s
Legacy:
Making
history
every
day
Other:
If
your
presentation
or
workshop
does
not
fall
into
any
of
the
above
categories,
please
include
a
brief
description
of
your
focus
below.
Length
and
Time
of
Workshop
Workshop
Length
Single
Session
(50
minutes)
Double
Session
(110
minutes)
(only
offered
on
Saturday)
Preferred
Time
Please
indicate
your
preferred
time
to
present.
Please
note
that
preferences
will
be
given
based
on
date
of
proposal
submission.
 Friday
evening
 Saturday
morning
 Saturday
Afternoon
Are
you
willing
to
deliver
this
workshop
more
than
once?
Yes
No
Audience
Preferences
Target
Audience
Please
check
all
that
apply.
 Advisors
 Emerging
Leaders
 First
Generation
College
Students
 Programming
Boards
 Fraternity/Sorority
Members
 Student
Government
Members
 Residence
Hall
Students
 Community
Members
 Other
(Please
specify)
Audience
Size
We
know
that
some
workshops
are
geared
to
a
larger
audience
and
others
require
a
smaller
group.
To
facilitate
room
assignments,
please
indicate
your
intended
audience
size.
Please
check
all
that
apply.
 10-­‐20
 20-­‐30
 30-­‐40
 40-­‐50
Audio
Visual
Equipment
A/V
Requests

5. CLCO 2013 Workshop and presentation application form
5
Please
indicate
your
A/V
needs
below.
This
includes
electronic
needs
as
well
as
hard
materials
such
as
flip
charts
and
markers.
NOTE:
All
rooms
are
equipped
with
PCs
and
projectors.
If
you
plan
to
use
your
own
laptop
or
a
flash
drive,
please
indicate
below
and
please
allow
time
to
set
up
before
your
presentation.
(Mac
users,
please
provide
your
own
adaptors).
Agreement
NOTE:
Each
presenter
must
sign
the
following:
Photo
Release
-­‐-­‐
REQUIRED
All
presenters
are
asked
to
agree
to
the
following:
I
hereby
give
the
Student
Ambassador
Leadership
Program
the
absolute
right
and
permission
to
copyright,
publish
or
use
photographs
of
media
which
may
be
included
in
whole
or
in
part
or
composite
or
distorted
in
character
or
form,
in
conjunction
with
my
own
or
fictitious
name,
or
reproductions
thereof
in
color
or
otherwise,
made
through
any
media
that
SALP
chooses
or
hires
someone
to
create
and/or
reproduce,
for
art,
advertising,
use
on
SALP
or
Columbus
State
website,
in
publications,
trade
or
any
other
lawful
purpose
whatsoever.
I
hereby
waive
my
right
to
inspect,
and/or
approve
the
finished
product
of
the
advertising
copy
that
may
be
used
in
connection
therewith,
or
the
use
to
which
it
may
be
applied.
I
have
likewise
communicated
this
photo
release
information
to
all
of
my
co-­‐
presenters,
if
applicable,
and
attest
that
they
have
also
agreed
to
its
terms.
I
am
18
years
of
age
or
older
and
I
am
competent
to
contract
in
my
own
name.
I
have
read
this
release
before
signing
below
and
I
fully
understand
the
contents,
meaning
and
impact
of
this
release.
NOTE:
Anyone
under
the
age
of
18
must
have
a
parent
or
guardian
sign
this
form,
and
indicate
below:
I
give
my
child
permission
to
participate
and
agree
to
the
terms
listed
above.
Yes/No
Electronic
Signature
-­‐-­‐
Please
Type
Full
Name
By
typing
or
signing
your
name
below,
you
acknowledge
that
you
have
read
and
understood
the
photo
release
above,
that
if
selected
you
will
present
this
workshop
at
the
Columbus
State
Leadership
Conference,
that
all
presenters
and
co-­‐presenters
must
register
for
the
conference
by
October
(CSCC
faculty
and
staff
exempt),
that
you
understand
that
Columbus
State
does
not
provide
stipends,
honoraria,
or
travel
expenses
to
presenters,
and
that
all
co-­‐presenters
(if
applicable)
have
seen
and
agreed
to
these
terms.
Name:
Date:
Please
type
in
the
date
of
submission
and
electronic
signature.